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Am J Obstet Gynecol. 2012 Aug;207(2):114.e1-7. doi: 10.1016/j.ajog.2012.06.027. Epub 2012 Jun 19.

Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification.

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  • 1Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan.



The aim of the present study was to differentiate and specify the subtypes of adenomyosis.


Surgically treated adenomyosis (n = 152) was subcategorized retrospectively into 4 subtypes on the basis of magnetic resonance imaging geography. Subtype I (n = 59) consisted of adenomyosis that occurs in the uterine inner layer without affecting the outer structures. Subtype II (n = 51) consisted of adenomyosis that occurs in the uterine outer layer without affecting the inner structures. Subtype III (n = 22) consisted of adenomyosis that occurs solitarily without relationship to structural components. Adenomyosis that did not satisfy these criteria composed subtype IV (n = 20). Stepwise logistic regression analysis was used for specification of the subtypes.


Subtypes I-III were suggested as a product of direct endometrial invasion, endometriotic invasion from the outside, and de novo metaplasia, respectively. Subtype IV was a heterogeneous mixture of far advanced disease.


Adenomyosis appears to consist of 3 distinct subtypes of different causes and an additional subtype of indeterminate cause.

Copyright © 2012 Mosby, Inc. All rights reserved.

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